Microsurgery Offers New Hope for Breast Cancer Survivors with Lymphedema

Women with
breast cancer who
have lymphedema in
their upper arm experienced
reduced fluid in the swollen arm
by up to 39 percent after undergoing a
super-microsurgical technique known
as lymphaticovenular bypass, report researchers
at The University of Texas
M. D. Anderson Cancer Center. The
results from the prospective analysis, presented
at the 88th Annual Meeting of the
American Association of Plastic Surgeons,
suggest another option for women with
breast cancer who are considering ways
to manage lymphedema, a common and
debilitating condition following surgery
and/or radiation therapy for breast cancer.

Lymphedema results when the lymph
nodes are removed or blocked due to
treatment and lymph fluid accumulates
causing chronic swelling in the upper
arm. There is no cure or preventive
measure for lymphedema, and it is
difficult to manage. According to
the National Cancer Institute, 25 to
30 percent of women who have breast
cancer surgery with lymph node removal
and radiation therapy develop
lymphedema.

Researchers evaluated 20 women with
breast cancer with stage II and III treatment-
related lymphedema of the upper
arm who underwent a lymphaticovenular
bypass. Due to lymphedema, the
women’s affected arms were an average
of 34 percent larger compared
to the unaffected arm prior to the
surgery. Of these 20 women, 19
reported initial significant clinical improvement
following the procedure.

“Surgical techniques [to reduce
lymphedema] have been limited and
therefore have been met with skepticism
by surgeons, making it extremely
important to determine which new techniques
promise to bring real benefits to
patients,” says lead author on the study
David W. Chang, MD, professor in the
department of Plastic Surgery and director
of the Plastic Surgery Clinic at
M. D. Anderson.

In lymphaticovenular bypass surgery,
surgeons use tiny microsurgical tools to
make two to three small incisions measuring
an inch or less in the person’s
arm. Lymphatic fluid is then redirected
to microscopic vessels to promote drainage
and alleviate lymphedema.

Dr. Chang notes that while most
effective when completed in earlier
stages before the affected arm is fibrotic,
almost anyone with breast cancer
who has lymphedema stage I, II, or III
is a candidate. Though breast cancer
was the focus of this study, the surgery
can also be performed on people who
have lymphedema in the leg resulting
from cancers involving pelvic regions.
Long-term follow-up is necessary to
determine if the procedure continues to
promote drainage after one year.

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This article was originally published in Coping® with Cancer magazine,
May/June
2009.